Knee Osteoarthritis is the inflammation of the cartilage in your knee joint. The knee is a hinge joining consisting of the Tibia, femur and patella (see image below).

Table of Contents for Knee Osteoarthritis 

What is Knee Osteoarthritis?
What are the symptoms of Knee Osteoarthritis?
Treatments for Knee Arthritis
How can I manage Knee Arthritis?
 – Weight Loss
 – Increasing Activity
 – Over The Counter Medication
 – Exercises Therapy
Top 5 Tips for Healthy Knees

As you can see the femur just sits on top of the tibia and is stabilised on the outside and inside by strong ligaments called your medial ligament and lateral ligaments. There are also two other ligaments in the center of the joint called the Anterior Cruciate Ligament and Posterior Cruciate Ligament. These ligaments prevent the femur from sliding forward and backwards on top of the Tibia; when all these ligaments work together the knee joint is a very stable joint.
The patella is what we call a sesamoid bone which is contained in the quads tendon. Now without getting too complex it creates a lever as it presses against the groves in the femur as the quad muscle contracts to extend (straighten your knee). At the back of the knee there are the hamstring muscles and the heads of the Gastroc Muscles(Calf muscles) which provide more stability posteriorly.

All in all the knee joint can both absorb force as it lands on our foot during walking/running but also facilitates a stable base when we push off to propel ourselves forward.

The main reason knees will get injured is due to a lack of strength in your knees. Muscles can deteriorate over time if they are not stressed enough. I know you may say you walk a lot or run a lot but that doesn’t necessarily mean your thigh muscles (quads and hamstrings) are strong enough to contend with the activity.

When they are not strong enough the mechanics of your knee changes and during each step the knee may move excessively. The most common movements we see is the knee moving too far forward or knee drifting inwards as we walk or runOver many many many 1000’s of steps the knee pain starts to become inflamed as the structure within the knee starts to absorb too much force as the muscles around the knee are not doing their job. The muscles may be fatigued or just not strong enough. This can lead to a breakdown in the cartilage in your knees which is what we refer to as osteoarthritis.

What is Knee Osteoarthritis?

Knee osteoarthritis (OA), as we mentioned, is an inflammation in your knee which results in the breakdown of cartilage (meniscus) in your knee. Cartilage acts like a shock absorber within the knee to dissipate forces through the knee joint during walking/running or going up and down stairs.

Over time (years) this cartilage may begin to break down so that your knees start to become creaky and make grinding noises when you move them. This is normal and does not cause alarm. Having noises in your knee is natural and as physios we are not concerned about this unless it starts to become painful.
To note; the latest research shows that almost everybody over the age of 50 will have some form of degeneration in their joints as a result of a lifetime o

f activity. Some people have more severe OA than others but either way this condition must be managed rather than cured as the cartilage cannot regenerate itself.

What are the symptoms of Knee Osteoarthritis?

Common symptoms of knee arthritis is:

• Reduced range of movement when you bend your knee or straighten your knee
• Your knee may not bend fully and may be painful when your bend it or when you go to kneel down it may feel tight
• Your knee may look more swollen than one of your other knees which is a sign of swelling or inflammation within the joint
• Your knee may have some clicking sound that are painful
• Pain after prolonged sitting or lying
• Pain worse in the morning- stiff and creaky
• After a long walk your knees maybe achey for the rest of the day or the next few days
• Some people experience more knee pain walking on uneven surfaces such as sand or in a wet field

Treatments for Knee Osteoarthritis

There are many treatments for OA but the general consensus among the experts is that prevention is key to longevity. If you are concerned about your knees go see your physiotherapist as they are the experts when assessing the quality of your knee joint. They can recommend some exercises to help strengthen the area around your knee and your hips and ankles.
But why hips and ankles? Well as your knee is just two bones sitting on top of each other it needs to gain some stability from your ankle and hips to protect itself and develop a movement strategy that reduces load on that knee. The more control and strength you have around all your joints the healthier they will be. Some people may have weak knees but extremely strong ankles or hips which protects the knees but in my experience if you have weak knees and either weak ankle/hip from previous injuries this will lead to further injury somewhere in that limb. So it is best to strengthen the entire limb to increase longevity and protect it from further damage.

If you have more painful knees there are options to manage your pain.
You can avail of corticosteroids, Hydrocortisone or steroid injection to reduce pain and inflammation. This will give you a window of opportunity then to strengthen your knees without flaring it up. These are the most common methods to manage pain but they can provide only short term relief and are not guaranteed to work in every patient. In my experience only 50% of people may get any significant relief from this injection and usually will require a second or third injection at some point in the future.

You can also opt for a Hyaluronic Acid injection which injects a high viscous fluid into your knee to lubricate the joint. The full process on how this injection works is unclear but it does show promising results when combined with some lifestyle changes that I will mention in the next section.

How can I manage Knee Osteoarthritis?

As I mentioned previously, prevention is better than cure. So how can you manage OA in your knees?

Weight Loss

Losing weight has shown to be beneficial for reducing knee pain but you have to consider the processes at play here. To lose weight you must first become more active, so it is the weight loss or the increase in activity that is helping reduce your knee pain. Some people are worried about their weight affecting their knees but gaining an extra 4-5kg will not have much effect on your knees. Weight gain in the region of 15-20kg will start to have an effect on your knees. If your Body Mass Index (BMI) is over 30 or your percentage body fat is over 25% for male and 35% female then I would start to consider that your weight may be influencing your knee pain. But if we are just talking a few Kg you need not worry about that gain.

Increasing Activity

As we get older our activity levels start to decrease and we start to move less and therefore begin to lose muscle mass. Keeping a consistent exercise routine that includes walking, hiking and some resistance training has shown to improve knee pain and prevent Knee OA from progressing. The key word here is consistent. These activity changes should be slow and steady, this is a marathon not a sprint and choosing the correct intensity and exercises duration for your body’s capacity for exercise is something our physio team can discuss with you in the clinic.

Over The Counter Medication

Your GP can advise you on what anti inflammatory medication you can take to help combat knee pain and joint inflammation. These must be used as a short term solution to reduce pain in an acute flare up and are not recommended for long term use.

Exercises Therapy

Just like increasing your activity there are certain exercises classes that may help you on your journey to having healthy strong knees but again the biggest down fall I see in the clinic is that patient either underestimate or over estimate their ability.
When you underestimate your ability you are choosing an exercises that is too easy for you and you are not challenging your body enough to create a strength adaptation in your muscles. The opposite is for over estimation. Patients still believe they are 20 years old and dive right into an exercises that that is too advanced for them which ends up just pissing off your knee more. This will reduced consistent exercises and overall their exercises strategies will to be too inconsistent to provide any real change.
Get advice from the experts and follow it

Top 5 Tips for Healthy Knees

1. Exercises is key start slow increase gradually and be consistent
2. Get the advice from the experts- stop using Dr Google it never works as it does not provide context to your own lifestyle and exercises capacity
3. Get in tune with your knee figure out how long you can sit/walk.
4. run before it becomes sore that will give us a great starting point to show your progress when you start a new fitness regime.
5. It is most definitely a marathon so don’t sprint out of the block!

This Article was written by Diarmuid Hegarty, Clinical Director ReSync Physiotherapy, MICP MSc Physio, MSc Sports Med, NSCA. Our team are here to answer any questions or queries you may have about your pain/injury. We offer Free Consultation for people who are unsure if physiotherapy is right for them.